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Tuesday Mar 01, 2016

Teaching Abroad Helps Grow Family of Family Medicine

I recently returned from Saudi Arabia, my fourth trip there in the past seven years and the first with a new passport. Planning for the trip gave me the occasion to thumb through my old, expired passport and reflect on all the places I have traveled to on behalf of the AAFP's Advanced Life Support in Obstetrics (ALSO) program.

Lots of memories -- joyful and wonderful experiences, frustrating travel disruptions and memorable international colleagues who struggled to provide the best possible medical care under often challenging circumstances.

And yet, in my years of teaching ALSO in resource-challenged countries, I rarely encountered family physicians providing maternity care. In almost every case, the participants in the global ALSO courses were obstetricians or nurse midwives. In many of the countries I have visited, family medicine is not well established, and physicians who provide general medical care in the community rarely interact with hospitals or provide maternity care.

That clearly is changing around the world as family medicine residency programs are established and graduates enter their communities to provide comprehensive, family-centered care across generations.

In decades past, many U.S. physicians generally thought of global medicine as missionary medicine. American doctors, the thinking went, travel to developing countries to provide short-term medical care to underserved populations, often in association with philanthropic and faith-based organizations. But there are incredible examples of dedicated family physicians who contribute their time, energy and funds to support international programs and provide continuity of resources to communities that otherwise would not have health care. Several of my extraordinary community colleagues rank among them.

The AAFP partnered with the Kansas-based non-profit organization Heart to Heart International and the AAFP Foundation to start Physicians with Heart in the former Soviet Union in 1993. In nearly two decades, the project helped provide support, training and mentorship to local family medicine associations and family physicians in the countries of the post-Soviet era. In collaboration with local health authorities and ministries of health, Physicians with Heart developed and conducted family medicine education and training events. The project also coordinated airlifts of much needed pharmaceuticals, medical equipment and supplies, as well as educational materials.  

I got started in international and global medicine when Physicians with Heart brought the ALSO course to the former Soviet Union. Today, the Academy continues to support our members in their global health work and initiatives to support nascent family medicine associations, provide basic and continuing medical education, sustain ongoing family medicine residency training, and help support family physicians in countries where the specialty is having difficulty becoming established and growing.

Our Academy members' participation in the World Organization of Family Doctors, or Wonca, has expanded our international horizons even further. The incredible energy and enthusiasm of our young family physicians in Wonca's Polaris Movement for New and Future Family Physicians in North America is wonderful testimony to the realization that we are one global community, all striving to improve the life and health of those we serve.

Many medical school applicants have already participated in global health(www.aamc.org) activities, and many U.S. medical schools and family medicine residency programs have well-established international and global health rotations, areas of concentration and global health tracks. Involvement in global health lets us see and learn more about conditions that are rare in U.S. medical practice. But it also equips us to provide care to underserved communities and multi-cultural populations in the United States, including refugees, immigrants, asylum seekers and other transnational groups.  

It is important to remember how much we can learn from our international colleagues. The United States ranks last among the most highly developed nations in life expectancy, penetration of universal preventive health measures and global cost of care. Those countries that have better health care outcomes with lower costs have strong family medicine and primary care communities, as well as proven strategies to ensure primary care access for everyone.

I started this blog talking about my recent trip to Saudi Arabia for a reason. You see, during my second trip to Riyadh in 2011 I was introduced to Abdullah al-Owayed, M.D., a United Kingdom-trained family physician who was the first chair of the first department of family medicine in Saudi Arabia. I was asked to give a talk on the patient-centered medical home (PCMH) to a group of family physicians, all of whom had received their primary care training outside Saudi Arabia. Months after that visit, al-Owayed came to the United States and spent time in my group practice learning about our PCMH journey, and about our practice’s relationships with our local medical school and family medicine residency program.

On his return to Saudi Arabia, al-Owayed established his country's first family medicine residency. Just last month, I had the pleasure of having one of the first graduates from that residency participate in an ALSO instructor course. She is one of the pioneers of the new generation of family physicians in Saudi Arabia, providing maternity care as part of a comprehensive, full-scope family medicine practice.

How can you contribute to family medicine's development abroad? The AAFP has several networking mechanisms that may help you match to your interests and abilities with global health needs and efforts. An AAFP member interest group focused on global health and a number of member-initiated regional groups, as well as the annual AAFP Family Medicine Global Health Workshop, can provide you with resources, member experience and connections for your global health engagement. And the Academy's Center for Global Health Initiatives supports the professional needs of AAFP members who want to be globally engaged.

Carl Olden, M.D., is a member of the AAFP Board of Directors.

Posted at 10:12AM Mar 01, 2016 by Carl Olden, M.D.

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